Cytologic examination of bronchial brush specimens is among the most effective ways of diagnosing bronchogenic carcinoma when airway lesions are directly visualized. Although the combination of bronchial brush cytology and bronchial biopsy appears to be the most productive means of arriving at the diagnosis of carcinoma, the single best method in many investigators’ hands is bronchial brushing. In some studies, diagnostic specimens were obtained in approximately 90 percent of cases in which brushings were performed.
Bronchial brush specimens also can be helpful in precisely defining the type of tumor. Determination of cell type by cytologic evaluation seems to correlate well with the eventual findings at surgery or postmortem; in fact, this method is as accurate as bronchial biopsy in some studies. Immunocytologic markers have demonstrated utility in the determination of cell types of bronchogenic tumors. Cytomorphology has been shown to be accurate for the identification of the subtypes of small cell carcinoma, provided that adequate numbers of cells can be retrieved and that their preservation is good. website
Indeed, all of this work assumes that adequate numbers of pathologic cells can routinely be obtained and that they can be smeared onto microscope slides without contamination by drying or other sources of artifact. Yet drying of cells during the preparation of smears has been shown to be a major cause of inadequate cytologic results. Several authors have noted the susceptibility of bronchial brush specimens to the drying artifact, resulting in deterioration of cell quality and subsequent problems in the accurate diagnosis of cell type.
Recently, a new device has been introduced to reduce the number of cells lost and the amount of drying encountered in the preparation of cytology slides during fiberoptic bronchoscopy. The Saccomanno brush wash kit (SBW) consists of a small capsule containing 1 ml of fixative. Following sampling, the brush is extended past a plastic baffle into the fixative. It is then agitated against the baffle repeatedly, secretions and cellular material falling to the bottom of the fixative in the capsule (Fig 1). Subsequently, the capsule is centrifuged and the cell pellet used for the preparation of smears.
The purpose of this study was to determine whether the Saccomanno brush wash system provides an advantage for the recovery and recognition of malignant cells in bronchial brush specimens.
Figure 1. The Saccomanno brush wash kit has a small plastic constriction, or baffle, which aids in the removal of cells from the brush, depositing them in fixative. The conical shape allows formation of a cell pellet with minima] centrifugation.